SFO annual meeting opens door to the public

PARIS — In addition to the usual intensive program of presentations, posters, round tables, wet labs and symposia, this year’s meeting of the Societé Française d’Ophtalmologie was marked by the presence of two new events.

One was the involvement of the SFO in a program of continuous medical education, in collaboration with the University Board of Ophthalmologists and subspecialty societies.

“Our annual meeting, which gathers together more than 5,000 attendees, is the ideal place for providing qualified educational programs to an increasingly widespread ophthalmologic community, encompassing not only French ophthalmologists, but also a large number of foreign associates,” said Jean-Louis Arné, MD, president of the SFO. This year’s courses concentrated on glaucoma and neovascular retinal diseases, taught at both basic and advanced levels.

The second innovative event was a day, “A la vue du tous” (“in view for everyone”), open to the general public, during which specialists were available to provide information and answer questions on the popular topic of refractive surgery and on glaucoma, age-related macular degeneration and the ocular complications of diabetes.

“For the first time, our congress has opened the doors to all those who wanted to know more about both their health and our work. We wanted to provide them with information that was not biased by commercial interests or distorted by the filters of the media,” said Jean-Paul Renard, MD, general secretary of the SFO.

“This initiative also demonstrates that we are actively and increasingly involved in the domain of public health,” he said.

Neuro-ophthalmology

Neuro-ophthalmology was the topic of the 2004 annual report of the SFO, a publication coordinated by Avinoam B. Safran, MD, head of the ophthalmology department at Geneva University Hospital and president of the International Neuro-Ophthalmology Society. In presenting the book, Prof. Safran pointed out that ophthalmology and neurology are closely related.

“There is no ophthalmologic practice that is not, in some ways, neurological and vice versa,” he said. In other words, neurological disorders always affect the eye, and ocular disorders always affect the nerve centers that process visual information and control visual function.

Neuro-ophthalmology also demonstrates that visual perception is largely based on unconscious processes, as manifested by phenomena such as subliminal perception, blind vision and “filling in” of visual defects, Prof. Safran said.

“In the process of perception, the image that we receive is a combination of reality and illusion, and the threshold between the two is not clearly defined,” he said.

He explained that visual field defects, such as central scotoma caused by retinal vessels or the deterioration of peripheral vision in glaucoma patients, can be “filled in” by the brain by using the information received from the surrounding areas of healthy retina.

Glaucoma survey

A one-day survey, carried out by the “Comité de lutte contre le glaucome” (Committee to Fight Against Glaucoma) with a contribution from Pfizer Laboratories, revealed an interesting picture of the French situation concerning the epidemiology, risk factors and treatment of glaucoma and high IOP.

French ophthalmologists were asked to include all glaucoma or high IOP patients over 18 years of age who were seen during the day of the survey.

The total number of patients affected by these pathologies in France is estimated to be approximately 600,000 to 700,000. It is estimated that there are a similar number of cases that have not been diagnosed.

In the study, 3,896 patients were examined by 1,173 ophthalmologists on 1 day. Primary open-angle glaucoma was found to be the most frequent form of the disease, accounting for 61% of the total number of cases.

“On average, French ophthalmologists dedicate to glaucoma consultations half a day per week, which is not a negligible rate,” said Max Villain, MD, in presenting the results of the study.

It was also shown that a majority of patients (87%) are under medical treatment and that surgery is still a relatively infrequent procedure.

“Another interesting discovery was that patients tend to be inconsistent in following medical treatment and in attending follow-up visits. The interval between consultations ranges between 10 days and 10 years, with a mean of 7 months. This is because glaucoma can be quite asymptomatic in the early stages. Yet it is an insidious, progressive disease, hence the necessity of a more accurate information of the patients,” Dr. Villain said.

Refractive surgery

LASIK and surface treatments have an equal number of supporters when it comes to laser refractive surgery.

Joseph Colin, MD, said that he thinks customized PRK is the best option.

“It is true that custom LASIK induces fewer aberrations than conventional LASIK, but custom PRK does more, as it reduces preoperative aberrations in the majority of cases. In particular, it is effective in reducing spherical aberrations, which greatly affect visual quality,” he said.

LASEK is becoming more popular, especially in the epi-LASIK variation that involves the mechanical separation of the epithelium. Another possibility, according to Thierry Bour, MD, is LASEK with manual disepithelialization without alcohol (LASEKSAM), made possible by special, inexpensive instruments. As for LASIK, Etienne Hachet, MD, introduced the Lepto-LASIK (thin-LASIK) technique in which flap thickness is reduced to less than 100 µm, 30 µm above Bowman’s membrane.

“This method has all the advantages of LASIK, such as fast recovery, stability of results and patient’s comfort, but also has the optical quality of LASEK or PRK,” he said. “Contrast sensitivity is good, there are no halos and glare in night vision, and wavefront analysis shows a lesser quantity of higher-order aberrations.”

Cataract surgery

Advances in cataract surgery include Alcon AquaLase, a liquifaction device available on Alcon’s Infiniti phacoemulsifier, which replaces ultrasound with a water jet, and the technology of micro-lenses for bimanual microincision surgery. Gilles Lesieur, MD, compared the four models of micro-lenses currently available: ThinOptX Ultra Choice 1.0, Physiol Hydriol Slim, Acrimed Acriflex and Acri.Tec Acri.Smart.

An investigation of cataract surgery practices in European countries was presented by Serge Zaluski, MD. Health care systems are very different, with a variable proportion of public and private medical care.

“Wherever public health care prevails, there are waiting lists for cataract surgery with a waiting time varying between 2 and 12 months,” Dr. Zaluski said.

Fees for cataract surgery were difficult to compare, due to the variations between private and public remuneration and the different tax systems.

“However, low charges were recognized as the cause for low quality medical care,” he said.

AMD

An epidemiological study on the prevalence of age-related macular degeneration in the European population over 65 years of age confirmed the importance of known risk factors, such as age, female sex, cardiovascular diseases and smoke. A total of 4,754 people from seven European countries (Estonia, France, Greece, Italy, Northern Ireland, Norway and Spain) were included.

“Results were homogeneous in all countries. We found that 47.6% of the population had no premonitory sign of AMD, 2.5% had high-risk lesions and 3.3% had manifest AMD. Two-thirds were wet forms of AMD,” said Alain Zourdani, MD.

Contrary to expectations, iris color was not a significant factor, and no difference was reported between northern and southern European countries. These findings minimize the role of light exposure as a risk factor for AMD, Dr. Zourdani said.